21R0202 - Attachment A5 Customer Invoice Format.pdf

ATTACHMENT 5 – Customer Invoice Format

Invoices are generated for Ancillary Charges and associated fuel deliveries and are provided to the customer. Each invoice shall contain the following data elements:

Page 1 of Invoice –Summary Page

• Header with program name DLA Energy SEA Card® Program, SEA Card® Invoice, Invoice

Date [insert invoice date], Invoice Number: [insert contractor invoice number]

• Customer Acct # [insert account number]

• Customer Name: [insert vessel name]

• Branch of Service: [insert BOS]

• Payment Terms: [insert 30 days]

• Due Date: [insert due date]

• Attention: [insert billing name, Address and Phone Number

• Header for Contract Fuel Purchases (if applicable) o Contract Number o Delivery Receipt Number o AO PIN/Transaction Date o Vessel o Dollar Amount Owed (USD) o Total Amount

• Header for OM Fuel Purchases (if applicable) o OM Contract Number o Delivery Receipt Number o AO PIN/Transaction Date o Vessel o Dollar Amount Owed (USD) o Total Amount

• Header for Ancillary Charges o Contract Number o Delivery Receipt Notice Number o Lift Date o Vessel Name o Dollar Amount Owed (USD)

• Total Amount

• Email and phone number contact for contractor submitting invoice

• Cage Code

• Tax Identification Number

• Contract Number: / Misc Ancillary Charges – contract number DLA Energy has with contractor, abbreviated to last seven digits

• Contractor Name and Address

• Customer Account Number (payment office)

• Invoice Number

• Invoice Date

• Payment Terms

• Statement as follows: If paying [Contractor Name] by check, send check payable to

Contractor Name and Address

• Statement as follows: Please make EFT payments to: Name of Bank, ABA Number and Account number

• Current Amount Due Header for entry field

• Amount Paid Header for entry field

Page 2 of Invoice

• Header with program name DLA Energy SEA Card® Program, SEA Card DRN, Date of Invoice, Billing Reference/Invoice Number

• Account Number

• Customer Name (vessel name)

• DoDAAC

• Branch of Service (HL2 Name)

• Hull

• Vessel Name

• APC/JSN/ORG

• Fund Code

• Signal Code

• Ancillary LOA

• Port

• Port Address

• Port Phone Number

• Transaction Date

• Transaction ID

• Order Number

• DRN

• Requisition Number and

• DLA Energy Order No.

• Delivery Date

• Header for Fuel Purchases. If fuel isn’t being billed, insert statement that there are no fuel charges to be billed.

o Contract # (if applicable) o CLIN (if applicable) o Delivery Date o Quantity o UoM o Unit Price o Total

• Hard code following statement: “Fuel Purchases are billed by DLA Energy. Values displayed is the fuel amount DLA Energy pays”.

If fuel order was cancelled and resulted in ancillary charges, display “Fuel order cancelled, and ancillary charges incurred”.

• Header for Ancillary Charges o Contract # (if applicable) o CLIN o Ancillary Charge o Delivery Date o Quantity o UoM o Unit price o Total

• Repeat for additional ancillary charges

• Invoice Total

Page 3 of Invoice

• Header with program name DLA Energy SEA Card® Program, SEA Card Billing Summary, Invoice Date

• Acct #

• Customer Name

• BOS

• Payment Terms: 30 Days

• Due Date

• Billing Name, Address and Phone Number

• Invoice Counter - # (Number of invoices formatted as page 2)

Header: Ancillary Charges in Current Billing Period

• Contract # - DLA Energy contract # with fuel supplier name (enter separate row for subsequent Items)

• DRN #

• AO Pin/Transaction Date

• Vessel DoDAAC and Name

• Amount (USD) enter additional ancillary charges, if applicable

Total

DLA Energy SEA Card® Program

SEA Card® Invoice Page:1

Invoice Date:

Billing Reference --

Invoice Number:

15-Feb-2021

Customer Acct #: 3235 Customer Name: USS Sioux City Branch of Service: Department of Navy Payment Terms: 30 Days Due Date: 17-Mar-2021

Attention: LT Nathan Jackson Address: 1600 Ely St

Marinette,WI 54143 Phone: (904) 270-3647

Contract Fuel Purchases AO Pin/

Contract # DRN Transaction Date Vessel Quantity

Total

Ancillary Charges For Fuel

Contract # DRN Transaction Date Vessel Amount(USD)

23890 08-Feb-2021 V20140 USS Sioux City $5,000.00

Total $5,000.00

Contact us for support by email [insert email address] call toll-free [insert phone], or mail inquiries to [insert mailing address].

Customer Acct #: 3235 SEA Card® Program Customer Name: USS Sioux City [insert contractor mail address] Invoice Number: xxxx Invoice Date: 15-Feb-2021 Tax ID: xx-xxxxxxx CAGE Code: xxxxx Payment Terms: 30 Days Contract #: 21-x-xxxx / Misc Ancillary Charges

If paying [contractor name]. by check, Please make EFT payments to: [bank name] please send payment to: ABA #: xxxxxxx [insert contractor mail address] Acct #: xxxxxxx

Make checks payable to [contractor name]

CURRENT AMOUNT DUE:

AMOUNT PAID:

$5,000.00

SAMPLE INVOICE

mailto:customer-support@seacardsys.com

SEACARD DRN Page:2

Invoice Date:

Billing Reference --

Invoice Number:

15-Feb-2021 xxxxxxx

Customer Acct #: 3235 Customer Name: USS Sioux City

DoDAAC: V20140 Branch of Service: Department of Navy

Hull Number: LCS 11 Vessel Name: USS Sioux City

APC/JSN/ORG: 056521

Fund Code: 39 Signal Code: A

Ancillary LOA: AA17118046B1B260D3825 0565212DV20140

Port: PONCE Location: CLIPPER OIL COMPANY Location ID:

Phone: (619) 692-9701

San Diego, CA United States

Transaction ID: 4022193 DRN: 23890 Transaction #: 23890 Req# / PO#: V20140-1029-6900 Transaction Date:

SEA Card® Onli

08-Feb-2021 53575

Bunker Contract #:

DLA Energy Order 5601

CLIN: Delivery Date: Quantity UoM Unit Price Total Item:

Fuel order cancelled and ancillary charges incurred.

* Fuel Purchases are billed by DLA Energy. Values displayed is the fuel amount DLA Energy pays.

CLIN: Delivery Date: 01-Feb-2021 Quantity UoM Unit Price Total Item: Cancellation Charge 1 Each $5,000.000000 $5,000.00

Invoice Total $5,000.00

. SEACARD Billing

Summary

Page:3

Invoice Date: 15-Feb-2021

Customer Acct #: 3235 Customer Name: USS Sioux City Branch of Service: Department of Navy Payment Terms: 30 Days Due Date: 17-Mar-2021 Invoice Count: 1

Attention: LT Nathan Jackson Address: 1600 Ely St

Marinette,WI 54143 Phone: (904) 270-3647

Ancillary Purchases in Current Billing Period

Contract # DRN Transaction Date Vessel Amount(USD)

23890 08-Feb-2021 V20140 USS Sioux City $5,000.00

Total $5,000.00